If CRB65=0: Amoxicillin
500mg TDS
5 days
or Clarithromycin
500mg BD
5 days
or Doxycycline
200mg stat then 100mg OD
5 days
If CRB65=1,2 & AT HOME, clinically assess need for dual therapy for atypicals:
Amoxicillin
500mg TDS
7 days
+/- Clarithromycin
500mg BD
7 days
or Doxycycline alone
200mg stat then 100mg OD
7 days
Start antibiotics immediately
Use CRB65 score to guide mortality risk, place of care & antibiotics Each CRB65 parameter scores 1: Confusion (AMT<8); Respiratory rate >30/min;
BP systolic <90 or diastolic ≤60; Age >65;
Score 3-4 urgent hospital admission; Score 1-2 intermediate risk consider hospital assessment; Score 0 low risk: consider home based care.
Always give safety-net advice and likely duration of symptoms. Mycoplasma infection is rare in >65s.
If no reponse to antibiotics after 2 weeks consider possibility of lung cancer or tuberculosis and arrange chest X-ray. Seek risk factors for Staph aureus and Legionella.